Oh, dear

I have, blessedly, very little experience with nursing homes.

Both of my grandfathers died young, and neither of my grandmothers spent any time in a nursing home.

My Grandmother Wolf died in the hospital, but she had been living in her own home and - at the age of 78 - still shoveling her own snow. (When she died, I was 29, and 78 seemed like such great old age to me. The thought of someone shoveling snow at 78 seemed just preposterous. Little did I know.)

My Grandmother Rogers died in my Aunt Margaret's house, a month short of making it to 97. One of her brothers, my Great Uncle Pat, also made it to great old age, but spent the last couple of years of his life in a nursing home. Curiously, it was right next to my grandmother's house, just up the hill. She was still in her home when Pat was in Clark Manor, and she could hobble out to her porch (in Worcester parlance, her piazza) and wave to Pat standing in his nursing home window.

Next generation: my father (age 58) and most of my uncles died young - or at least youngish. Not one made it much past 65. My mother's brothers: dead at 45 and 52. So, no nursing homes for them.

My mother died (age 81) in a hospital, but she was living pretty independently up until the end. A year before she died, she had sold the house we grew up in and moved into a congregate, lightly assisted facility just across the street from her parish church. She could walk to daily Mass. Hallelujah! She had a lovely one bedroom apartment, two meals a day, and light housekeeping and laundry taken care of. Hallelujah! 

While she did died in a hospital, she almost died with her boots on, as she had three trips (Chicago, Cape May NJ, and Vienna and Prague) in the works when she embarked on the ultimate journey.

My Aunt Margaret (85) did die with her boots - make that pumps - on. On the day she died, she drove out of her driveway in the home of 60 years, went to Mass, went to the Star Market, went to the library, drove home and parked in the driveway, and took what turned out to be her final nap. Oh, and she was shoveling and chopping ice up until the end, if her son-in-law or grandsons didn't get over there quickly enough for her liking.

Peg's death is how everyone wants to die. (As a kid, I remember the nuns yammering on about praying for a happy death. Happy death? Say what? What's happy about death. Now I get it. If I prayed, I'd pray for a happy death. Just like Aunt Margaret's.)

My incredible Aunt Mary did die in a nursing home. Incredible because she lived independently until a few years before her death. She moved into an assisted living facility, but her health declined and she required a high level of care (heart, mobility and vision issues), so she had to go into a nursing home. Perfectly fine nursing home, but she was miserable.

When I say that Mary was incredible, I mean incredible. She was tough, smart, sharp, with it, active. Up until near the end of life, if someone told you she was 10, or even 20, years younger than what was on her birth certificate, you'd believe it. 

I didn't get to see Mary very often, as she lived in Chicago, but it was only once she was in the nursing home that she sounded like an old lady on the phone.

My generation: the two deaths of those closest to me - my husband, and my oldest and dearest friend - happened in hospice. Jim had just turned 70, Marie was 64. Too young, way too young. And way too young for nursing homes.

But many people - even at a relatively young age - do need the level of care provided by a nursing home. 

Good luck to them...

As was reported in the Boston Globe the other day, there's a labor shortage writ large in the nursing home industry. Chalk it up to low pay and poor working conditions. Covid burnout. Just plain regular burnout. Immigration crackdowns.

The nursing homes around here are short of staff. Many have had to cut the beds they offer, and hospitals are left scrambling trying to find places to discharge elderly patients to when they require care that they can't get in their homes. 

One nursing home mentioned in the article:

...spends $10,000 a month advertising nursing home jobs...[and] offers registered nurses $4,000 signing bonuses and takes over their student loan payments when they come onboard. (Source: Boston Globe)

Even with enticements like these, "...more than a third of 180 staff positions are vacant."

Staff are being pressured to work extra hours, pushing many of them out the door. 

At a time when people have been quitting their jobs at record rates, nursing homes have been dealt a particularly devastating blow. The labor shortage was an issue well before the pandemic, and now it’s ballooned to historic highs, with 6,900 open nursing staff positions in long-term care facilities across the state — a 22 percent vacancy rate, according to the Massachusetts Senior Care Association, an industry trade group. Most of these skilled nursing facilities are heavily dependent on Medicaid reimbursements, which means pay is typically less competitive than in hospitals or other health care facilities. The number of immigrants, many of whom work in nursing homes, has also fallen sharply.

Meanwhile, our population (including - ugh! - me) is aging. 

Add on that a lot of nurses are leaving the direct patient care side of the nursing profession or working for temp agencies, often - for the young - traveling around the country from gig to gig in cities they want to live in for a while. Temps get paid more than staff professionals, and can refuse night and weekend work. No surprise that tensions can run high.

Then there are the workers lower down the skill totem poll: aides, building and grounds, cleaning, food service. The lower the wages a worker earns, the more likely they are to be enticed by another job, even if it only means making a buck or two more an hour.

So, yes to more services that help the old and frail stay in their homes. 

But that'll only get you so far.

When someone has greater impairments, they need to be in a place where there's 24/7, skilled nursing care. And let's not even get into Alzheimer's and other dementia diseases.

So, yes to opening up immigration to help fill in some mighty big gaps.

Oh, dear.

This picture? That's me, off to utter an atheist's prayer for a happy death.

Oh, dear.